FACILITATION MANUAL
INTEGRATING GENDER
INTO HIV/AIDS PROGRAMMES
Prepared by:
Honorine Mwelwa Muyoyeta
HM Consultancy Services
Box 34736, Tel/Fax 239289
Lusaka.
And:
Dr. Alex Simwanza
National HIV/AIDS STI/TB Council
Box 38718, Tel: 255092
Lusaka.
Zambia
Funded By The World Bank In Collaboration With The Gender In Development Division (GIDD)
November, 2003
1
Table of Contents
Acronyms
Overview of the course
Background
Summary of modules in the manual
3
4
4
7
Module One
Introduction of participants and facilitators
8
Module Two
Understanding Gender and HIV/AIDS
Understanding Gender
Understanding HIV/AIDS
9
9
17
Module Three
Gender and HIV/AIDS linkages
Gender power relationships
Poverty, gender and HIV/AIDS linkages
Risks and vulnerability for men and women
22
22
23
24
Module Four
Gender mainstreaming
Introduction of tools for gender analysis
Incorporating gender aspect into HIV/AIDS planning
Experiences, challenges and opportunities in Zambia
31
31
36
39
Module Five
Monitoring and Evaluation
52
References
67
2
ACRONYMS
AIDS
ANC
ART
ARV
CBOH
CBOs
CSO
CSW
DDCC
DOTS
FBOs
FTE
GIDD
HIV
HMIS
IEC
IGAs
M&E
MOH
MTCT
NAC
NGOs
OIs
OVC
PLWHA
PMTCT
PPAZ
PRSP
SFH
STDs
STIs
SWAAZ
TB
TBA
TOR
UNZA
VCT
VSU
ZNBTS
Acquired Immune Deficiency Syndrome
Ante Natal Clinic
Anti Retroviral Therapy
Anti-Retroviral
Central Board of Health
Community based Organisations
Central Statistical Office
Commercial Sex worker
District Development Coordinating Committees
Directly observed Treatment short course
Faith Based organisations
Full Time Equivalent
Gender in Development Division
Human Immuno Deficiency Virus
Health Management Information System
Information, Education and Communication
Income Generating Activities
Monitoring and Evaluation
Ministry of Health
Mother to Child Transmission
National Aids Council of Zambia
Non Governmental Organisations
Opportunistic Infections
Orphans and Vulnerable Children
People Living With HIV/AIDS
Prevention of Mother to Child Transmission
Planned Parenthood Association of Zambia
Poverty Reduction Strategic Programme
Society For Family Planning
Sexually Transmitted Diseases
Sexually Transmitted Infections
Society for Women Against AIDS in Zambia
Tuberculosis
Tradition Birth Attendant
Terms of Reference
University of Zambia
Voluntary Counseling and Testing
Victim Support Unit
Zambia National Blood Transfusion Services
3
OVERVIEW OF THE COURSE
A.
BACKGROUND
The purpose or goal of this Training Manual is to build the capacity of Trainers in order
for them to systematically integrate Gender Dimensions into HIV/AIDS programmes
(Mainstreaming). In order to accomplish this purpose, the Training Manual will equip
trainers with the following:
•
•
•
•
•
•
•
•
B.
An increased understanding of gender and gender issues.
Knowledge on the inter- linkages between gender and the spread, management and
control of HIV/AIDS.
Understand linkages between gender, poverty and HIV/AIDS.
Knowledge on how to go about integrating gender into HIV/AIDS using tools for
gender mainstreaming.
Understanding how to identify and develop gender-related strategies of addressing the
health needs and concerns of both men and women for the purpose of (i) reducing
vulnerability to HIV/AIDS and (ii) mitigate the impact of HIV/AIDS.
Knowledge of biological, Socio-cultural and economic factors that contribute to
men’s and women’s differing vulnerability to HIV infections.
Approaches for empowering women and men in combating the HIV/AIDS pandemic.
Understanding on the need to build local institutional linkages and partnerships as an
effective response to the issues of gender and HIV/AIDS.
WHO WILL USE THIS MANUAL
This is a trainer’s manual. The trainer will be someone who has completely understood
the basic ideas expressed in each section of every module as well as the overall purpose
of the entire programme.
The trainer should be capable of using the manual flexibly so that sessions can be
designed to adapt concepts and ideas to the local situatio ns. This manual is not intended
to be used by trainees.
C.
HOW TO USE THE MANUAL
This manual should be used as a source of information. The trainer should be familiar
with all the concepts in each module before attempting to begin the programme. The
reason for this is that the trainer will then be able to explain the theme in his/her own
words and use suitable language for the trainees. It will also enable the trainer to prepare
training aids, which are suitable for the local environment.
4
Many of the instructions are guidelines which the trainer should adapt creatively to suit
the needs of the trainees and the realities of the local situation. In each module the
following format is used:
D.
1.
2.
2.1.
3.
4.
5.
6.
7.
8.
STANDARD FORMAT FOR ALL MODULES
Number Of Module
Topic Of Module
Sub-Topic Of Module
Objective Of Session
Time
Methods
Aids
Materials
Session Guide
Session Guide should outline the steps to be followed by the facilitator and how the
materials should be used. There should be instructions step by step to the end of the
session
Each session should flow as follows:
o
Introduction and definition of subject
o
Other steps to follow as applicable
Specific objectives
These are given at the beginning of each module i.e. what the trainer is trying to achieve
during this session.
The Briefing Notes
These consist of a short introduction to the module. They also provide guidelines about
the methods to be used and suggest examples for carrying out some of the exercises.
A Work Plan
This consist of the suggested method, training aids, total time allocated for each activity
and instructions for the suggested activities within the session. Activities are described in
detail and the time to be allocated to each separate activity is given.
Trainer’s Instructions
They give more detailed information about tasks to be carried out.
5
Trainer’s Tips
They are given whenever it is necessary to supplement the instructions. They suggest
alternative approaches and help the trainer achieve a clearer focus on the topic.
A Summary
This is given at the end of the each session. It describes what the session should have
achieved. The trainer should find out whether trainees’ progress at the end of the session
matches the objectives given at the beginning. The trainer should conduct an evaluation
at the end of each session.
It is recommended that trainers select topics most relevant to the needs of the trainees.
The duration for each module can be extended or shortened depending on the depth and
detail of discussion desired.
EXAMPLE:
1.
2.
2.1.
3.
4.
5.
6.
7.
8.
E.
Module Four
Gender mainstreaming
Introduction of tools for gender analysis
Objective Of Session
To enable participants understand and use the tools for gender
analysis
Time: X Hour/S
Methods : Participatory presentation and discussion in the plenary session
Aids – Overhead, Projector Etc.
Materials: (Relevant Handouts/Visuals)
Session Guide
8.1. Define gender mainstreaming (participants brainstorm)
8.2. Collect responses on flip chart and agree on common definition (compare with
already prepared definition)
8.3. Identify various tools used for gender analysis in buzz pairs, pairs report back
and add on those not mentioned by participants
8.4. Introduce each tool, explain and demonstrate ho w it is used in a participatory
presentation
8.5. Group Work, participants practice using the tools and report back
8.6. Summarise and conclude
THE TRAINING METHODS
The training uses a participatory methodology by getting trainees involved in supporting
the trainers to prepare exercises, energizers and facilitating daily evaluations. This
creates a feeling of joint responsibility and fosters a successful mutual learning process.
Exercises are used throughout the course to practice the introduced techniques.
6
F.
WORKSHOP SCHEDULE AND PROCEDURES
Participants agree on ground rules to follow during the sessions.
The suggested participants’ jobs during the workshop are as follows:
Job
Day 1
President
Trainer’s
assistant
Time keeper
Record keeper or
rapporteur
Evaluation
facilitator
Day 2
Day 3
Day 4
A President and a time-keeper for the workshop from among the participants to be
elected to provide the required leadership. The president would be a link between
participants, organizers of the workshop and motel or hotel service providers.
G.
SUMMARY OF THE MODULES IN THE MANUAL
The table below summarises how the whole training in terms of the tools, methods and
approaches to be used for each module.
MODULE
1. Introduction of participants and facilitators
2. Understanding gender and HIV/AIDS
3.Gender and HIV/AIDS linkages
4. Gender mainstreaming:
4.1. Introduction of tools for gender
analysis
4.2. Incorporating the gender aspect into
HIV/AIDS Planning
4.3. Experiences, challenges and
opportunities
5. Monitoring and Evaluation
TOOLS
•Presentations Discussions Case studies
Group work
• Gender power relationships (Analysis of influencing
factors) using levels of causation framework
• Poverty, gender and HIV/AIDS linkages . Can you include
the gender dimensions into the framework on povertyHIV/AIDS vicious circle
• Risks and vulnerability for men and women. Kindly
improve on the gender inequalities diagram for both men
and women and identify their risks and vulnerability.
Discuss Activity and Income profile table
Discuss Access and Control Profile
Presentations on planning
Group exercise
•Review of HIV/AIDS Strategic Plan
Group exercise to relate Activity profile by sex to HIV/AIDS
Strategic Plan in - target as recipient and provider
•
•
•
Presentations
Exercise to review M&E Plan of HIV/AIDS ( Log Frame
with indicators)
Case study
7
MODULE ONE:
INTRODUCTION OF PARTICIPANTS AND FACILITATORS
Objective:
Introduction in an informal atmosphere
Learn more about each other’s personal background
Time:
Method:
Aids
Materials
15 minutes
Session Guide :
Objectives:
Participants learn more about each other’s personal background
Time:
15 minutes
Methods:
Sharing information with a partner, discussion
Aids: Board markers, pin board, coloured metaplan cards, one marker for each
participant
Materials:
Session Guide:
1.
Conduct the exercise “My secret wish”
Ask the participants to introduce themselves to each other more personally. This can be
done either individually or by exchanging information with the partner next to her/him on
the following aspects:
• Position, institution and main duties
• Work and home address
• Marital status, number of children, hobbies, etc
• A secret wish: “What I always wanted to do, but could not do because I am a
man/woman”.
2.
Each secret wish is written on a coloured card (one colour for men, one colour for
women).
3.
Each participant introduces her/himself or the participant beside her/him giving
the information from the above points including the “secret wish”.
4.
While the participants are being introduced, collect all cards and put them on the
pinboard in separate columns for men and women. Group them according to their
contents.
8
MODULE TWO
UNDERSTANDING GENDER AND HIV/AIDS
TOPIC 2.1.
INTRODUCTION TO THE CONCEPT OF GENDER
Objectives:
Participants understand the difference between “sex” and “gender”
Time:
60 minutes
Methods:
Sharing information with a partner, presentation, discussion
Aids: Overhead projector, LCD, whiteboard, board markers, pin board, coloured
metaplan cards, one marker for each participant
Materials:
Visual 1
“Sex versus gender”
Session Guide:
1.
Ask the participants to explain the difference between “sex” and “gender” and
write their interpretations vertically under each term on the whiteboard. Show
overhead 1 and compare it with the participants’ statements.
2.
Give the participants the opportunity to ask questions about the definition of both
terms and invite other participants to answer.
3.
Invite one participants to stand beside the pinboard and read the cards with
participants’ secret wishes. Ask the other participants to indicate for each wish if
it is
a) gender-related- implying that the wish could be fulfilled if the society changed its
norms and gender specific role definitions
b) sex-related-referring to biologically determined unchangeable factors
4
During the analysis mark the gender-related wishes with a green and the sexrelated wishes with a blue marker. Very likely you will have a majority of genderrelated issues reflecting the existing social-cultural barriers and limitations the
participants experience.
Ask the participants what they can learn from this exercise.
5.
To deepen the analysis you can ask the participants why their secret wishes could
not be fulfilled. Write their explanations on the whiteboard. You can refer to this
list of “influencing factors” when explaining the categories for gender analysis.
9
HANDOUT
PRESENTATION ON UNDERSTANDING GENDER
a)
Definition of gender and sex
Gender
•
Refers to the relations between men and women in society which arise out of the
roles they play. Such roles are socially constructed and not physically or
biologically determined.
•
Gender roles and relations are learnt, can be culturally specific and cross-cultural,
and change over time.
Gender & Sex
•
The term gender refers to the socially defined or constructed sex roles, attitudes
and values which communities and societies ascribe to as appropriate for one sex or
the other.
•
On the other hand, sex refers to a person’s genetic, physiological or biological
characteristics, which indicate whether one is male or female.
•
Gender therefore refers to how women and men are perceived and expected to
think and act because of the way society is organised, not because of biological
differences.
Gender Roles:
•
Gender roles are classified by gender, in that this classification is social, and not
biological. (For example, if child rearing is classified as a female role, it is a female
gender role, not a female sex role, since child rearing can be done by men or
women).
•
Gender roles are learned and vary widely within and between cultures. As social
constructs, they can change.
•
Gender roles determine access to rights, resources and opportunities.
Sex Roles:
o
Are roles that are performed in relation to the biological, reproductive attributes of a
persons body
SEX VERSUS GENDER
SEX
GENDER
Biological
Cultural
Given at Birth
Learned through socialization
THEREFORE:
THEREFORE:
Cannot be changed
Can be Changed
EXAMPLE
EXAMPLE
Only Women can give
Birth
Women and men can work as teachers,
Engineers, Labourers etc.
Only men can impregnate
Women and men can take care of children and the elderly.
10
b) Social Construction Of Gender (Socialization)
Socialisation is a process through which a person learns all things that he/she needs to
know in order to function as a member of a specific society. It is:
i.
ii.
iii
iv.
Constructed by society,
Developed over time
Defines rules, roles and sanctions for behaviour for men and women
Remain relevant to new and changing needs of culture
All this is done through a very systematic process. The following are some institutions of
socialization: family, community, school and work place
c) Gender Analysis
Gender analysis entails a close examination of a problem or situation in order to identify
the gender issues. Key issues include: a) the division of labour for both productive and
reproductive activities: b) the resources individuals can utilize to carry out their activities
and the benefits they derive from them, in terms of both access and control: and c) the
relationship of (a) and (b) above to the social, economic and environmental factors that
constrain development
Gender analysis of a development programme involves identifying the gender issues
within the problem which is being addressed and in the obstacles to progress, so that
these issues can be addressed in all aspects of the programme – in project objectives, in
the choice of intervention strategy and in the methods of programme implementation.
d) Gender Discrimination:
Gender discrimination occurs when individuals are treated differently on the grounds of
their gender. In many societies, this involves systemic and structural discrimination on
the grounds of gender against women in particular, in areas such as:
•
•
•
The distribution of income,
Access to resources,
Participation in political, economic and security decision- making.
Gender Equality
Gender equality means that there is no discrimination on grounds of a person’s sex in
the allocation of resources or benefits, or in access to services and the law. Gender
equality may be measured in terms of whether there is equality of opportunity, and
equality of results.
11
f) Gender Mainstreaming
Mainstreaming is a strategy for making women’s as well as men’s concerns and
experiences an integral dimension in the design, implementation, monitoring and
evaluation of policies and programmes in all political, economic and societal spheres so
that women and men benefit equally and inequality is not perpetuated.
Mainstreaming requires changes at different levels within institutions in agenda setting,
policy making, planning, implementation, and evaluation.
Instruments for the mainstreaming effort include: New staffing and budgeting practices,
training programmes, policy procedures and guidelines.
Mainstreaming a Gender Perspective is defined as the process of assessing the
implications for women and men of any planned action, including legislation, policies
and programmes, in any area and at all levels.
h) Critical Gender issues and concerns in Zambia
•
At macro level, gender irresponsive policies and programmes;
•
Persistence of powerful patriarchal systems that affect customs, traditional norms,
laws and practices;
•
High levels of gender inequalities in access to and control over resources such as
education, economic opportunities, other productive resources etc;
•
The supreme law of the land that does not promote gender equality:Ø
Ø
•
existence of a dual legal system;
selective domestication of international conventions and instruments that
Zambia has signed.
Misconception about gender at all levels, and poor gender capacities in the public,
private and parastatal sectors.
12
Topic 2.2.
PERCEPTIONS OF GENDER ROLES
Objectives:
Participants reflect together about their perceptions of gender roles
Participants understand tools used to perpetuate perceptions of gender
roles
Time:
90 minutes
Methods:
Game, role play and discussion
Aids:
Materials:
Session Guide:
1.
Ask participants to state their understanding of the term “perceptions”
2.
Tell participants that you will play a game making their perceptions of gender
roles visible.
Ask participants to stand up and gather in the middle of the room. Point out an imaginary
line.
Statements on gender roles (examples)
•
•
•
•
•
•
•
Men are more rational than women
The division of tasks between men and women reflects traditional cultural values
which have to be respected
If husband and wife are both working outside the house and the performance of the
domestic duties becomes a problem, the career of the man should be given priority
A woman can become a professional in her work field, but she should never forget
her duties as a wife and mother
Men will never be as good at childcare as women
Nowadays men and women already have the same rights and opportunities, the
women have only to make an effort to realize them
In development projects it is more important to address imbalances between
economic classes than gender differences
13
3. Discuss the following tools as they are used to reinforce or deter perceptions
Proverbs
Songs
Traditional Counsellors
What are the implications/impact on status of both female and male especially in
HIV/AIDS
Perceptions
1.
2.
3.
4.
5.
6.
women should not eat gizzard eggs back at a chicken
women don’t make good managers
women are the ones to look after the sick
men must provide
women must be submissive
women should wear beads around waist.
14
CASE STUDY I
TESTIMONY OF A MALE CARING FOR THE CHILD
Name
Sex
Age
Profession
Employer
Position
House
1.
:
:
:
:
:
:
Musonda Kunda
Male
40
Sociologist
Ministry of Agriculture and Cooperatives
Senior Sociologist – Policy and Planning Branch – Mulungushi
Introduction
As a young man brought up on the Copperbelt looking after children was not part of my
everyday work
Completed school and university education the same continued
Got married in 1990
2.
Real Issue
Lost job before our first born was born
Looked after child when mother was away for work (from 06:30 to 18:00hrs) everyday.
Jobs included
Take charge of Napkins
Vaccination and other clinic programmes
Feeding
Entertainment
3.
Community Response
Disappointed
4.
Lessons Learnt
Men can also look after children
There is nothing impossible that a man cannot do in child care
5.
Results Of The Care
Develop a deep relationship with the child
Enhanced relationship between me and my wife.
Demonstrated what a man can do about child care to the local community
15
HANDOUT
EXAMPLE OF PROVERBS, SONGS AND TRADITIONAL TEACHINGS
Proverbs from other countries
Gender in proverbs
Who is quoting? Whose views are represented?
Whose power is perpetuated, at the expense of whom
A hundred proverbs, a hundred myths”-Spain
An old proverb will never break” Russia
Proverbs are the cream of language” Afar. Proverbs are the horses of speech” Nigeria
Proverbs on women and men
Mother as the only category of women favourably portrayed
A wife should be like one’s mother” Swahili
Mother often seems to prefer sons to daughters
No matter how beautiful and talented a girl is, a boy is always more valuable” China
Women are more unfaithful than men
Men are warned not to fall for the women’s charms and evil intentions
Like the scorpions, woman is relative of the devil. When she sees a poor wretch, she
wiggles her behind and moves away” India
The silent and submissive type of a woman is highly recommended
Virtuous is a girl who suffers and dies without a sound” India
Proverbs from Zambia
Local language
Akaume takachepa
Mukaintu welede kumwa
Ubuchende bwamwaume tabonaula nganda
Abanakashi mafi yampombo
Mayo mpapa naine nkakupapa
Umwaume mwaume
Fisanga abaume, abanakashi fibakumanyafye
Translation
A man is never young
A woman should be beaten
A man’s philanderity does not break a house
Women are like a duicker’s faeces. Women can be
picked and damped by men because they are many.
Mother do me a service, I shall also do you one
A man is a man
Problems occur to men, women are just accidental
bearers. Men are regarded to be strong to handle all
problems.
One of the tools used to depict gender perceptions and roles are proverbs and sayings.
Using proverbs and sayings from different parts of Zambia, the trainers help participants
appreciate that proverbs are quoted in specific social and cultural context to portray
common beliefs and attributes. In the context of gender, these beliefs and attitudes are
used to evaluate, validate and reinforce societal attitude towards males and females.
Participants should note that the implications of such societal beliefs and attitudes for the
roles, responsibilities and status of male and female have different impacts on them,
usually disadvantaging the female. These beliefs and attitudes are internalized.
16
TOPIC 2.3.
UNDERSTANDING HIV/AIDS
Objectives: Participants should gain knowledge on the basic facts about HIV/AIDS
a)
Define and state the symptoms of HIV and AIDS.
b)
Describe how HIV/AIDS is transmitted.
c)
Discuss human sexuality
Time :
Methods:
Aids:
Materials:
90 minutes
Game, role play and discussion
Session Guide:
1.
Ask participants to state what they think HIV/AIDS is. Have all answers on a flip
chart.
2.
Ask participants to state how they think HIV/AIDS is transmitted. Have all
answers on a flip chart.
3.
Prepare three large cards on which the following statements are written:
True
False
Not sure
Place the cards at different points on the wall or floor. On different pieces of paper write
several statements that represent strong feelings about HIV/AIDS.
Read out the statements, one at a time and ask the participants/learners to stand next to
the card that best represents their view.
Risk behaviours associated with HIV transmission
•
Having unprotected sex.
•
Having more than one sexual partner.
•
Prostitution.
•
Alcohol and drug abuse.
•
Experimenting sex.
•
Sharing skin cutting or piecing instruments.
•
Desiring to produce a baby when HIV infected.
Ask the members of each group to explain why they hold such a view. Accept their views
without being judgmental.
Later use the feedback to give your input and straighten out any misconceptions held by
the learners/participants, reinforce positively any correct views held.
17
HAND OUT
Definition of HIV
HIV is an abbreviation that stands for Human Immunodeficiency virus and it is the name
of the microorganism that causes AIDS.
Definition of AIDS
AIDS is an acronym that stands for Acquired Immune Deficiency Syndrome and it is a
condition characterized by multiple illnesses due to the weakness of the body's defense
against illnesses. HIV is the causes this weakness.
The relationship between HIV and AIDS
HIV is the germ that causes AIDS. When a person has been infected with HIV, the germ
weakens the body's defense against illnesses. The body then is unable to fight off
illnesses. It is when these illnesses have occurred that we say that a person has AIDS.
AIDS is therefore an outcome of HIV infection.
In some cases, a person with HIV infection has the virus in his/her body but remains
strong and health for years. This person though not sick, can still pass the HIV infection
to others.
Signs and symptoms of HIV/AIDS
Major Signs
–Weight loss of more than 10%
–Diarrhoea for more than 1 mth
–Fever for more than 1 mth
Minor Signs
Cough for more than 1 mth
–Herpes zoster
–Thrush
–Persistent glandular lymphadenopathy
–Loss of memory
–Loss of intellectual capacity
–Peripheral nerve damage
Modes of HIV transmission
HIV is found in blood, sexual fluids. (Semen in men and vaginal secretions in women)
and breast milk. This means that HIV is only spread in three ways:
Fluids and risk of spreading HIV
High risk
Medium risk
Low risk blood
traces
No risk
Blood, Semen,
Vaginal/cervical
•Breastmilk
Saliva, Urine, Faeces,
Vomit Internal fluids
(health staff)
Tears ,sweat
18
a) Sexual Transmission
HIV can be transmitted from an infected person to his/her sexual partner - man to
woman, woman to man, man to man, woman to woman. In this case, sexual intercourse
refers to penetrative vaginal, penile-anal, genital oral or genital- genital contact.
b) Exposure To Infected Blood Or Blood Products
Sharing sharp instruments that cut or pierce the skin, e.g. traditional tattooing or
unsterilized injections.
c) Mother To Baby
HIV can be passed from mother to her baby during pregnancy, delivery or breastfeeding.
Note: People infected with HIV are both infected and infectious for the rest of their
lives. Even when infected people have no symptoms or outward signs, they can
still transmit the virus to others.
HIV Risk Reduction Behaviours
•
•
•
•
•
•
•
Have a mutually faithful relationship between uninfected partners. This carries no
risk of STDs and HIV. Testing for HIV may be necessary at the beginning of a
relationship to detect a symptomatic infection.
If you are not in a mutually faithful relationship, always use latex condoms for
vaginal or anal intercourse.
If one partner gets infected with an STD, both partners should be treated and must
complete treatment.
When infected with an STD, either abstain from sex until treatment is completed or
use latex condoms.
Avoid alcohol/drug abuse because this leads one to loss of self-control and can
easily lead one to sexual activities with infected persons.
Avoid sharing injection equipment and needles of any kind, even skin piercing
objects.
Avoid impregnating or getting pregnant if you are not sure of your HIV status.
Note: The ABC of risk reduction
A - Abstinence from sexual activity.
B - Be faithful to one partner (mutually Faithful).
C - Condom use with all sexual partners.
TOPIC 2.4.
UNDERSTANDING THE CURRENT STATISTICS ON HIV/AIDS
19
Objectives:
Participants should understand the current statistics
Participants should discuss what drives the HIV/AIDS epidemics
Participants should discuss the impacts of HIV/AIDS
Time:
Methods:
Aids:
Materials:
90 minutes
Discussion, presentation
HAND OUT
a)
Current status
Prevalence And Underlying Factors
Currently 16 per cent of the adult population aged 15 to 49 are living with HIV. About
8% of boys and 17% of girls aged 15-24 are living with HIV. Approximately 39.5 per
cent of babies born to HIV positive mothers are infected with the virus.
The percentage of HIV infected people by age and sex shows that females are more
infected. Young women aged 15 to 19 are five times more likely to be infected compared
to males in the same age group. Girls/women from age group between 15-24 are more
affected by the pandemic. And men aged 35-45 are also more infected than women. What
that means is that,
1.
Old men infect young girls
2.
Young girls infect boys
3.
Young men become old men and infect their partners and vise versa. The
cycle repeats itself.
Gender inequalities do exist as they are extrapolated in education attainments,
occupation, employment status and decision- making. Resulting from this inequality,
women engage in high-risk income generating behavior due to their economic
dependence and low social status including higher level of poverty. The economic
situation and the fact that young girls are preferred by older men could push yo ung boys
into acts of violence.
The current Zambia Demographic Health Survey (2002) results indicate that:
• Females in general have less access to information than their male counter parts.
• 85% of women believe that a husband is justified in beating them for at least one
reason as a sign of love.
•
53% of women agree that a woman can refuse sex with her husband under certain
conditions.
20
•
•
•
•
Husbands have a much greater say in decision making than wives.
Widowed and women in union experience less sexual violence than
separated/divorced and never married women.
Women with higher education experience more sexual violence than women with
no education.
Among women who report having ever experienced sexual violence, 42% were
forced 1 to 3 times in the past year and 11% were forced 4 or more times.
Illnesses and deaths
In June 2000, there were 830,000 people over the age of 15 years living with AIDS. Of
these 450,000 were women while 380,000 were men.
Since the advent of the HIV/AIDS epidemic the TB case rate increased nearly five-fold to
over 500 per 100,000 persons in 1996. There are now in excess of 40,000 new
tuberculosis cases reported every year. The tuberculosis co- infection has also resulted in
an increased mortality rate of TB patients on treatment by over 15%.
Consequences
The epidemic has left an estimated 620,000 orphans (in 2000), projected to reach 974,000
in 2014. Most of these will have no hope of obtaining formal education. In turn, this will
affect the quality of the labour force. Of the current orphans, 6% become street children
and less than 1% live in orphanages.
The impact of HIV/AIDS on the health care system itself has been profound. It is
projected that by 2014 AIDS patients will utilize 45 percent of all hospital beds,
crowding out othe r patients.
Socio economic impacts have led to the number of hours lost to illness and funerals
increasing three- fold from 13,380 hours in 1992/93 to 43,370 hours in 1994/95 at
Chilanga Cement Company. In addition, at Indeni Petroleum, the cost of medical care,
salary compensation for the families of deceased employees and funeral grants more than
doubled between 1991 and 1993, and had exceeded profits by 1996. Medical expenses
and training costs increased while person hours were reduced.
The Ministry of Education has less than two Full Time Equivalent (FTE) staff addressing
the sector’s response to AIDS although over 1600 teachers died of it in 1999 alone.
Zambia must now plan to train 2 teachers for each one who will actually teach.
21
MODULE THREE
GENDER AND HIV/AIDS LINKAGES
Objectives: Participants will be able to define the gender dimensions of the HIV/AIDS
Time:
90 minutes
Methods:
Discussion, presentation
Aids:
Materials:
Session Guide
In groups, participants will discuss three questions:
•
•
•
Gender power relationships (Analysis of influencing factors) using levels of causation
framework
Poverty, gender and HIV/AIDS linkages to include you include the gender
dimensions into the framework on poverty-HIV/AIDS vicious circle
Risks and vulnerability for men and women. Participants were asked to improve on
the gender inequalities diagram for both men and women and identify their risks and
vulnerability
Group 1 Question and presentation
Gender power relationships (Analysis of influencing factors) using levels of causation
framework.
•
Using the levels of causation framework, identify the gender power relationship
within political governance, poverty, economic, education, religious, environmental,
social-cultural and legal issues and check how these relationships fuel the spread of
HIV/AIDS?
Levels of Causation
Unprotected sex
With an HIV infected
Individual
Increases
Risk of HIV
infection
Level 3
Frequency and size
Reproductive
Purposes
Pleasure
Forced Sex
Rape & abuse
HIV positive
Sex as a
Sex for ritual
Commodity
purposes
For exchange
Experimentation
Level 2
Poverty,
Social cultural, Economic, Legal
Level 1
Economic Governance, Political Governance,
22
•
List examples of unequal power relations that prevent equitable development and
women’s full participation in all institutions of socialisation-family, community, schools,
workplace?
Group 1 Question and presentation
Factors of influence or underlying causes
1.Political
2. Social
3. Cultural
4. Poverty
5. Legal
Gender
Male
Remarks
Female
Parliament
Cabinet
Civil service
Education -Drop out rate
Religious Values -Moslems
-Christians
Tradition customs of sexual
cleansing
Socialization –Dominance
Submissiveness
Poverty levels
Employment –formal
-informal
Access to health care
Law of inheritance
Customary law-Polygamy
Dual application of statutory
and customary laws
Laws on child defilement, rape
Group 2 Question and presentation
•
Poverty, gender and HIV/AIDS linkages. Can you include the gender dimensions into
the framework on Poverty-HIV/AIDS vicious circle?
Poverty-HIV/AIDS vicious circle
Increased poverty
Poor or no education
Limited access to information
Poor healthcare, drug shortage, untreated
STDs
Unsafe income generating activities
Enhanced spread
of HIV/AIDS
Loss of trained human resource
Lower productivity
Lower GDP – increased national poverty
Increased number of orphans
23
How poverty enhances spread of
HIV/AIDS
Poverty Education -Drop out rate
Poor health care services
Unsafe IGAs
Employment –formal
-informal
How HIV/AIDS increases poverty
HIV/AIDS
Gender
Male
Remarks
Female
Gender
Male
Remarks
Female
Government
Business
Household
Group 3 Question and presentation
•
Risks and vulnerability for men and women.
Improve on the gender inequalities diagram for both men and women and identify
their risks and vulnerabilities
Gender inequalities
High risk income
generating behaviours
(CSW)
Higher levels of
poverty
High vulnerability to HIV
infection
WOMEN
Economic dependence
Low social status
Inability to negotiate for
safer sex e,g Condom use
Risk and vulnerability
Males
Female
24
HAND OUT FOR GROUP 1 EXERCISE
LEVELS OF CAUSATION
Unprotected SEX with an
HIV infected individual
Increases
infection
Risk
of
HIV
HIV positive
FREQUENCY AND SIZE
More male have frequent sex with more partner
Young girls are more likely to have sex
with more than one partner
Reproductive purposes
- male more say than female
POVERTY
- 80% OF which 63% - 69%
are female
LEVEL 3
Pleasure
Forced sex, rape, abuse
Sex exchange commodity Sex for ritual purposes Experimentation
- more male involved in - young children (girls)
- prostitution
more women affected
peer pressure
socialization than female - young girls and women -poverty (livelihood means) young children
inquisitiveness
at higher risk
LEVEL 2
SOCIO-CULTURAL
- burden more on female
than male
ECONOMIC
More men have access
and control over resources
LEGAL
Law especially customary law
disadvantages female
LEVEL 1
ECONOMIC GOVERNANCE, POLITICAL GOVERNANCE,
(MALE MORE ADVANTAGED THAN FEMALE)
POLITICAL GOVERNANCE
(NO POLITICAL WILL)
25
HAND OUT FOR GROUP 2 EXERCISE
POVERTY HIV/AIDS VICIOUS CIRCLE
Increased poverty
Poor or no education limited a
less to information poor health
care, drug shortage untreated
STDs Unsate in home gearing
activities
Enhanced
spread
of
HIV/AIDS
Loss of trained human reasurce
Lower productivity
Lower GDP increased National
Poverty Increased number of
ophans
27
How HIV/AIDS
increase poverty
GENDER
REMARKS
Governance
Male
High
Female
Low
Business
Formal
High
Low
Informal
Low high
HIV/AIDS
How poverty
enhances spread of
HIV/AIDS
Gender
Poverty
Loss of human
resources and so low
productivity due to
increased funerals and
absentenisan
Less productive labour
apply market. Lower
GDP so reduced
Production. Low
standards for people
Due to low sales in
informal business they
engage in unsafe
income generating
ventures like
prostitution
Remarks
Male
Female
Education drop out
rate
56%
70%
Fewer women attain high
education, the retire there is
low or limited access to
HIV/AIDS information and
therefore more vulnerable to
HIV/AIDS. Also not
understanding their rights
Poor health care
services
Low
High
Unsafe IGAS
employment
Formal
High
Low
Low
High
Sexuality transmitted
diseased not treated early
enough for women
Men take advantage of
women’s poverty and so
request for sexual favours so
increased unsafe ICAS
mean have access to
resources sex in work places
for employ , promotion puts
both sexes at risk
Poor quality jobs for women
and not valued such as street
reading and agriculture
work so go out for
prostitution to increase
income levels
Employment
Formal
Informal
SUMMARY
-
NEED TO ADDRESS THESE UNEQUAL GENDER POWER RELATIONS TO FOSTER
DEVELOPMENT THEREBY REDUCE INCIDENCE AND SPREAD OF HIV/AIDS
28
HAND OUT FOR GROUP 3 EXERCISE
RISKS AND VULNERABILITY
WOMEN
Prostitution sex worker crossboarder trader, fish traders
help pleasures (vulnerability)
Higher levels or poverty
WOMEN
High vulnerability
HIV Infection
to
Economic dependence low
social
Inability to say NO lack of negotiation low
purchasing power Hunger and strife Limited
choices to sex involvement low level awareness
and knowledge
29
MEN
High Demand on them
Enhance dominance on female
multiple partners
Economic power
High
vulnerability to
HIV infection
Socialisation
Peer
Pressure
Cultural values
Sexual cleansing polygamy – official
no official societal acceptance to
multipartite incest, defilement
deprivation of family income
30
MODULE FOUR:
GENDER MAINSTREAMING: USE OF TOOLS
4.1:
INTRODUCTION OF TOOLS FOR GENDER ANALYSIS
Purpose
Participants understand the tools for gender analysis.
Methods
Participatory presentation and discussion in the plenary session
Aids:
Overhead projector, whiteboard, board marker, large paper, markers, coloured
cards, 4 pinboards, pins
Materials:
Session Guide:
1.
Display the Activities and income profile table
Show the Access and Control Profile tool
Activities And Income Profile
Role
Women
Hrs/day- Income
Men
Hrs/day- Income
Productive work (generation of income in
money or kind)
-self employed
-wage labour/employed in
Reproductive work (maintenance of
human resources)
Socio-cultural activities
Participation in village grps, religious
Tool: Access and Control Profile
Resources
Men
Access
women
Control
Men
women
1. Natural
resources
Land
Capital
Tools
Production inputs
Vehicles
2. Markets
Labour
Commodity
-as buyer
-as seller
3. Socio-cultural resources
Information
Education
Training
Public services
31
HAND OUT
ACTIVITIES AND INCOME PROFILE
ROLE
WOMEN
MEN
HRS/DAY
INCOME
Marketer (vegetable seller)
HRS/DAY
INCOME
Marketers (spare-part dealer)
- Self Employed
13 hours
K10 000– K15,000
10 hours
K50,000 – K100,000
- Wage Labour/employed in
7 hours
K300,000/m
7 hours
K300,000/month
-Farming
REPRODUCTIVE WORK
(MAINTENANCE OF HUMAN
RESOURCES)
10 hours
K150,000/year
4 hours
K300 000/year
EDUCATION
HEALTH – CARE
FOOD (BUYING
AND PREPARING
SOCIAL CULTURAL
ACTIVITIES
2 – 4 hours
3 hours
4 hours
- participation in civic
activities
3 – 4 hours
NIL
NIL
NIL
- Political activities
2 hours
NIL
10hours
NIL
- Social Activities (Beer
Drinking)
NIL
NIL
4hours
K70,000 (spent)
Productive Work;
(Generation of Income in money
or kind
K5000/day
K5000/day
K10,000
1 hours
K20,00/day
0.30 hours K20,000/day
00.00 hrs
K50,000
IMPLICATION OF THE ABOVE ANALYSIS
-
Women spend more time on IGAs with low returns
-
Women spend more time on reproductive work, which is not acknowledged or appreciated.
-
Men are ready to give money on reproductive work rather than get involved themselves.
32
TOOL: ACCESS AND CONTROL PROFILE
ACCESS AND CONTROL AND RESOURCES
Access means:
To have the opportunity to use resources without having the authority to decided about produce/output and
the exploitation method
e.g. a landless worker who cultivates the land of somebody else and receives a share of the produce for
his/her work.
Control means
To have full authority to decide about the use and the output of resources
e.g. a landowner, factory owner, of a radio station.
RESOURCE
ACCESS
MEN
WOMEN
MEN
CONTROL
WOMEN
Productive Resources
LAND How do we intervene to
ensure controls output
XXX
X
XXX
X
XXX
XX
X
XX
XX
X
XXX
X
XX
XX
XX
XX
CAPITAL
TOOLS
PRODUCTION INPUTS
VEHICLES
MARKETS
LaBOUR
COMMODITY
AS BUYER
AS SELLER
SOCIAL
INFORMATION
EDUCATION
TRAINING
PUBLIC SERVICES
KEY
XXX Maximum
XX Average
X minimum
XX
XXX
XXX
X
X
X
HOW CAN WE ENSURE THAT BOT H MALES AND FEMALES PARTICIPANT AT ALL
LEVELS OF DECISION MAKING AND IMPLEMENTATION?
Sensitization:
-
approach – set them take the lead
build alliance, acceptance
33
Group work on Activity Profiles for men and women
Activity profile for males
11%
SLEEPING
16%
BATHING, EATING
42%
WORK
CLUB
RESTING AT HOME
26%
5%
Activity profile for females
6%
25%
SLEEPING
BATHING, EATING
6%
WORK
SUPPER
63%
34
GROUP WORK ACTIVITY PROFILE
TIME 17 HOURS
TIME
04:00hrs
06:00hrs
RURAL WOMEN
FARMING
ACTIVITY
Wake up
Water drawing and
carrying
Cleaning surrounding
Cooking prep
16:00hrs
In the field
Collecting firewood
Taking care of children
17:00 hrs
Pounding, meal
Preparation
Eat supper
Cleaning up
Go to sleep
18:30 hrs
20:00 hrs
21:00 hrs
12 HOURS MEN
RURAL MAN
TIME
04:00 – 06 hours
ACTIVITY
- wake up – check on fishing
fields
06:00 – 16 hours
walking to the
fields
16:00 -
chitemene
cutting down tree
small breaks
Return home
Rest,
Have supper
sleep
A.P
1.
2.
3.
Where’s the time
be mindful of time schedules to fit in other programme
division of labour disadvantages females
The two group work sessions on activity profile showed that women do a lot of work. In
addition when programmes such as home based care are introduced, the burden is more
on women. Therefore when planning and implementing various programmes or
interventions the following questions need to be considered:
•
How can we ensure that both males and females participate at all levels of decision
making and implementation?
Men and Women should participate equally in both income generating activities and
reproductive work; need to sensitize society on the need to share responsibility.
35
GENDER MAINSTREAMING: PLANNING
4.2:
INCORPORATING THE GENDER ASPECT INTO HIV/AIDS PLANNING
Purpose
Participants understand what planning is
Participants understand how a gender-differentiated approach can be incorporated
into the regular HIV/AIDS planning.
Methods
participatory presentation and discussion in the plenary session
group work
Aids:
Overhead projector, whiteboard, board marker, large paper, markers, coloured
cards, 4 pinboards, pins
Materials:
Overhead “Incorporating the gender aspect into the planning cycle”
Handout: “Incorporating the gender aspect into the planning cycle”
Session Guide:
1.
Discuss with participants What Is Planning? What does planning involve or what
are the steps in planning?
2.
Ask the participants to from three working groups. Each working group focuses
on one planning phase (identification, design, implementation) and elaborates
how a participatory gender-differentiated approach should be applied.
The application of the gender categories is not a separate undertaking cut off from the
routine tasks of planning (”conducting a gender analysis”), but the gender dimension
should be incorporated into all regular management steps during the life a project.
What happens at each stage?
PHASE
ACTION
APPLICATION OF GENDER
CATEGORIES
Identification
Design
implementation
Monitoring and evaluation
3.
The groups present and discuss their results. Refer to Handout 1 “Incorporating
the gender aspect into the planning cycle” when complementing and summarizing
the presentation of the working groups
36
HAND OUT
PLANNING AND INCORPORATING THE GENDER ASPECT INTO THE
PLANNING CYCLE
Discuss with participants What Is Planning?
Put thoughts together in a meaning systematic way. Forecasting
Looking ahead. Step of doing things ,Organize resources/activities
What does planning involve or what are the steps in planning?
Identification
Designing
Implement
Monitor and evaluate
Incorporating the gender aspect into the planning cycle
Phase
Identification
Design
Action
Conduct
analysis
situation
Establish system of
objectives
Formulate strategies
Discuss structural
set up
-institutional
-financial
Application of gender categories
Analysis of problems, actors, interests, visions, restrictions,
expectations and potentials in HIV/AIDS programme with regard to
-geographical conditions and demography
-target groups at grassroots level, including
-gender division of labour/roles
-access and control over resources
-socio-political position
-gender capacity of collaborating institutions
-policy framework for gender and development
Establishment of general objectives/inclusion of gender objectives
based on identification of gender needs
-Considering practical and strategic gender objectives
-With reference to the gender capacity of the collaborating
institutions
Elaborate planning
matrix
Outputs/results
-Outputs reflect at target group level:
patterns of access to and control over resources
intended changes of the socio-political position
(gender specific)
Activities
-Design of activities reflect the existing gender division of
labour/roles as well as intended changes
Indicators
-Specification of quantities and quality according to gender (who,
when, how much etc)
37
Phase
Implementation
Action
Elaborate plan
operations
of
Application of gender categories
-Gender-sensitive design of activities with regard to
-choice of technical package
-timing/duration/location
-eligibility criteria
-promotion strategy
-delivery system
-Allocation of sufficient and balanced budget for activities
with women and men target groups
-allocation of funds for training of staff in gender issues
Implement activities
-incorporating of gender aspects into TOR of all staff;
ensuring gender balanced team composition
Participatory
operation
management
-creating and observing gender balanced patterns of access
to and control over services, facilities and decision-making
at staff level
co-
-enabling the target groups to analyse their situation, plan
and implement activities at community level; ensuring the
incorporation of gender specific aspects in this process
-monitoring
institutions
gender
responsiveness
of
participating
Networking
-interacting with policy making institutions on gender and
development
Monitor
and
evaluate indicator
achievement
-Monitoring performance according to gender specific
indicators
Update baseline data
(gender specific)
-Revision of situation analysis based on gender categories
Assess impact
-Conducting a benefit analysis (Access to and control over
benefits at target group and institutional level)
Formulate
recommendations for
re-planning
-Adjustment of activities and policy according to gender
differentiated M&E results.
38
GENDER MAINSTREAMING: THE ZAMBIAN EXAMPLE
4.3:
EXPERIENCES, CHALLENGES AND OPPORTUNITIES
Purpose
Participants analyse how the gender aspect has been incorporated into National
HIV/AIDS Intervention Strategic Plan 2002-2003 so far and identify strategies to
enhance the gender perspective.
Methods
Participatory presentation and discussion in the plenary session,Group work
Aids:
Overhead projector, whiteboard, boardmarker, large paper, markers,
Materials:
Overhead “Incorporating the gender aspect into the planning cycle”
Session Guide:
1.
Ask the participants to split into groups.
2.
Invite the groups to reflect how the gender aspects has been integrated into the
Nationa l HIV/AIDS Intervention Strategic Plan 2002-2003.
Group work on gender mainstreaming in HIV/AIDS Strategic Plan
There are 3 levels of gender mainstreaming analysis namely:
a) Macro level- for developers and designers or governments. At this level gender
sensitive budgeting with a series of measures designed to ensure that public funds
benefit women as well as men. For example allocation of funds to social sector
instead of user fees.
b) Meso level- for service providers and organisations. At this level gender issues
should be in their policies, in provision of expertise, skills and knowledge of staff
and funding allocations.
c) Micro level- for recipients of services. At this level there is need to analyse the
impact of planned activities on both men and women and create scope to promote
more equality between them.
Each of the three groups should discuss two objectives of the National HIV/AIDS
Intervention Strategic Plan 2002-2003.
As part of problem identification and formulation each group should identify where each
of the two sexes was more heavily involved in the planning and implementation of the
intervention that have been identified as critical.
39
REVIEW OF NATIONAL HIV/AIDS STRATEGIC INTERVENTION PLAN 2002-2005 USING
COMBINED TOOL OF ACTIVITY AND ACCESS TO AND CONTROL OVER RESOURCES
Objective and outputs
Interventions
Involvement levels in the development and burden for
service providers and recipients
Developer of
Service
Recipient of the
programme
provider
service
M
F
M
F
M
F
REMARK
Indicate influencing factors
including access to resources
and control over resources
Indicate potential areas of
improvement
Reduce HIV/STI Transmission
Objective 1:
To promote the implementation
Of Multi-Sectoral Behaviour
Change
Communication
Campaigns by encouraging safe
sex practices and good health
seeking behaviours so as to
reduce HIV/AIDS prevalence in
the age group 15-19 from 15%
to 11% by 2005.
Output 1:
Improved awareness levels of
HIV/AIDS transmission modes
Output 2:
Sexual abstinence among the
youth and unmarried people
promoted
Output 3:
The practice of dry sex and
having multiple sex partners
discouraged.
Develop and disseminate
information
packages,
which are culturally
sensitive on safe sex
practices for different
categories of the sexually
active
Develop gender specific
interventions
Initiate and support work
place programmes on
prevention and impact
mitigation
Develop
and
Disseminate information
in a well targeted manner
Promote
life
skills
training
among
the
adolescents, youths
Involve
traditional
initiators and marriage
counsellors
Discourage
hazardous
cultural practices such as
sexual cleansing.
Empower the vulnerable
groups in negotiating sex
40
Objective and outputs
Interventions
Output 4:
Condoms made readily available in
public and private sectors.
Strengthen public sector
distribution of free condoms
by increasing distribution
points
Involvement levels in the development and burden for
service providers and recipients
Developer of
Service
Recipi ent of the
programme
provider
service
M
F
M
F
M
F
REMARK
Indicate influencing factors
including access to resources
and control over resources
Indicate potential areas of
improvement
Make condoms available at
affordable prices (Social
market ing)
Promote the use of male and
female condoms
Output 5:
Early and effective diagnosis and
treatment of STD ensured in men
and women aged 15-49 and pregnant
women.
Create conducive
environment for the private
sector to manufacture and
distribute condoms
countrywide.
Undertake education and
awareness campaigns on
STI’s
role
in
the
transmission of HIV
Ensure effective, screening,
treatment and continuous
supply of STD drugs at all
levels of health care
provision.
Make treatment for STI’s
easily available for high risk
groups.
41
Objective and
outputs
Interventions
Objective 2:
To
minimise
the
transmission of HIV from
mother to child by
increasing access to
quality facilities for
Prevention of Mother to
Child Transmission in all
the districts of the
country from 39% to
28% by 2005.
Community mobilization
and formative research
Output 1:
Increased number of
sensitized communities
Output 2:
Increased and better
functioning Prevention of
Mother
to
Child
Transmission (PMTCT)
service facilities.
Output 3:
Infant feeding options for
HIV/AIDS
infected
mothers encouraged
Involvement levels in the development and burden for
service providers and recipients
Developer of
Service
Recipient of the
programme
provider
service
M
F
M
F
M
F
REMARK
Indicate influencing factors
including access to resources
and control over resources
Indicate potential areas of
improvement
Provide specific health
education information to the
public.
Train health workers in
VCT, HIV/STI screening,
treatment and care.
Make
available
antiretrovirals and other
relevant essential drugs
Integrate Prevention of
Mother to Child services
into routine health delivery
in all districts.
Give
information
on
appropriate
feeding
alternatives and potential
risks to HIV positive
women.
Supply infant formula.
42
Objective and
outputs
Interventions
Objective 3:
To make all blood, blood
products and body parts
safe for transfusion and
to promote the use of
sterile
sharps
by
strengthening screening
centres and adopting
infection
control
measures by 2005
Output 1:
Management
procedures, guidelines
and standards for blood
bank services reviewed
and updated.
Review
and
update
selection, screening and
management procedures in
the collection, storage and
use of blood, blood
products and body parts.
Output 2:
Adequate
screening
centers, blood banks,
equipment for HIV,
syphilis, hepatitis B and
other infections provided
Output 3:
Use of sterile syringes,
blades, needles and other
sharp instruments by
general public, health
workers, traditional
healers/initiators and
community care givers
encouraged
Involvement levels in the development and burden for service
providers and recipients
Developer of
Service provider
Recipient of
programme
the service
M
F
M
F
M
F
REMARK
Indicate influencing factors
including access to resources
and control over resources
Indicate potential areas of
improvement
Provide blood bank staff
with appropriate training in
selection, screening and
monitoring skills.
Community mobilization
Apply effective blood
donor recruitment and
selection standards.
Provide adequate screening
Develop maintenance and
servicing programme for
equipment
Set up adequate safe-blood
banks in all districts
Develop and disseminate
targeted
information
packages
Make universal
infection control
measures a legal
requirement for
all practitioners.
Make available adequate
sterilisation equipment for
all institutions.
43
Objective and
outputs
Interventions
Involvement levels in the development and burden for service
providers and recipients
Developer of
Service provider
Recipient of
programme
the service
M
F
M
F
M
F
REMARK
Indicate influencing factors
including access to resources
and control over resources
Indicate potential areas of
improvement
REDUCE THE SOCIO -ECONOMIC IMPACT OF HIV/AIDS
Disseminate information, education
Objectives 4
To improve the and communication (IEC) materials
quality of life on Voluntary Counselling and
of
all Testing (VCT) and positive livin g
HIV/AIDS
through print, electronic and folk
infected
media
persons
without
Integrate VCT service provision into
symptoms by routine health service delivery
encouraging
system at the district level
positive living,
good nutrition, Expand
VCT
services
by
prevention of government and NGOs
opportunistic
infections and Improve quality of VCT services
avoiding high
risk behaviour.
Output 1:
Voluntary
Counselling
Testing
Centres
established in
all the districts
in the country.
44
Objective
and
outputs
Interventions
Involvement levels in the development and burden for service
providers and recipients
Developer of
Service provider
Recipient of
programme
the service
M
F
M
F
M
F
Output 2:
HIV/AIDS
advocacy
campaigns for
support,
services
and
human rights
for PLWAs to
be undertaken
countrywide
and
through
traditional
structures and
national
leadership
including
workplace.
Eliminate stigma associated with
HIV/AIDS
Output 3
Prevention of
opportunistic
infections
(OIs)
and
preventive TB
therapy
provided
to
HIV infected
people.
Make Prophylaxis for TB easily
available for PLWHA.
REMARK
Indicate influencing factors
including access to resources
and control over resources
Indicate potential areas of
improvement
Secure basic health and hygiene, and
have access to good nutrition, IGAs
for PLWHA
Strengthen support groups by
building capacity of PLWHA
Encourage communities to be more
open on issues of HIV/AIDS
Involv e
people
living
with
HIV/AIDS in policies, programmes
and
deliberations
related
to
HIV/AIDS.
Make Prophylaxis for
opportunistic
infection
available for PLWHA.
other
easily
Integrate and strengthen counselling
services provision into routine health
service delivery at district level.
45
Objective
and
outputs
Interventions
Output 4:
Institutions
offering
counseling
training
established and
strengthened
Identify and strengthen more
counselling
training
institutions/organisations.
Objective 5:
To
provide
appropriate
care, support
and treatment
to HIV/AIDS
infected
persons
and
those affected
by HIV/AIDS,
TB, STIs and
other
opportunistic
infections in by
the year 2005
Train and orient staff
Involvement levels in the development and burden for service
providers and recipients
Developer of
Service provider
Recipient of
programme
the service
M
F
M
F
M
F
REMARK
Indicate influencing factors
including access to resources
and control over resources
Indicate potential areas of
improvement
Enhance training of health workers
and community support groups in
counselling
and
psychosocial
support at district level.
Ensure uninterrupted and continuous
supply of TB and essential drugs at
affordable prices.
Implementation of directly observed
treatment short course (DOTS)
Ensure registration of all essential
drugs critical in the treatment of
opportunistic infections
Output 1:
Treatment for
Tuberculosis
and
other
opportunistic
infections
made available
or provided.
46
Objective
and
outputs
Interventions
Output 2:
Anti-retroviral
therapy (ART)
for
PLWAs
introduced in
public
and
private health
facilities
Select and equip sites for initial
introduction of ART
Involvement levels in the development and burden for service
providers and recipients
Developer of
Service provider
Recipient of
programme
the service
M
F
M
F
M
F
REMARK
Indicate influencing factors
including access to resources
and control over resources
Indicate potential areas of
improvement
Establish community support
groups,
Train health personnel in VCT,
clinical management of HIV/AIDS
laboratory testing and monitoring.
Introduce and use standardised
combinations
of
antiretroviral
therapy for eligible people living
with HIV/AIDS.
Develop guidelines on clinical
application of various combinations
of antiretroviral drugs.
Ensure uninterrupted and continuous
supply of palliative care, and
antiretroviral drugs at affordable
prices.
Ensure
registration
of
all
antiretroviral drugs brought into the
country
Create an enabling environment for
the procurement of antiretroviral
generics in the country.
47
Objective
and
outputs
Interventions
Output 3:
Improved
home
based
care
and
support
services for the
infected
provided.
Promote and strengthen hospice type
services and other forms of palliative
care
Involve the private sector and other
support groups in prevention, care
and
entrepreneurial
support
initiatives
Involvement levels in the development and burden for service
providers and recipients
Developer of
Service provider
Recipient of
programme
the service
M
F
M
F
M
F
REMARK
Indicate influencing factors
including access to resources
and control over resources
Indicate potential areas of
improvement
Support and strengthen NGOs,
CBOs and family based home care
groups.
Strengthen basic nursing skills to
promote quality nursing care among
service providers and family
members.
Involve government ministries and
departments in prevention, care and
support initiatives.
Output 4:
Mechanism for
validation of
the efficacy of
traditional and
alternative
remedies in the
treatment
of
HIV/AIDS and
other
opportunistic
infections
established.
Strengthen networking and referral
system among care givers and health
institutions.
Establish collaborative arrangements
between
formal
and
traditional/alternative
medical
practitioners.
Undertake necessary tests, studies
and research.
Support traditional institutions to
adopt effective approaches in the
treatment of HIV/AIDS.
48
Objective and
outputs
Interventions
Objective 6:
To provide Improved
care
and
support
services for the orphans,
vulnerable children and
others affected and at
risk such as refugees,
prisoners,
disabled
people by the year 2005
Strengthening technical and
management capacities of
CBOs and FBOs
Output 1:
Organizations
that
provide
education,
physical,
material,
social,
mental
and
spiritual support to
orphans and vulnerable
children created and
strengthened
Output 2:
Integration
and
reintegration of street
children
Involvement levels in the development and burden for service
providers and recipients
Developer of
Service provider
Recipient of
programme
the service
M
F
M
F
M
F
REMARK
Indicate influencing factors
including access to resources
and control over resources
Indicate potential areas of
improvement
Scale up and expansion of
effective programs that
strengthen community
schools
Ensure provision of
education, shelter, clothing
and other basic needs to
orphaned children
particularly the girl child
Promote community
participation in the welfare
of orphaned children
Provide relief and
psychosocial support to
guardians and care givers
Advocacy for Convention
of Rights of Children
Strengthen victim support
units
Support to networks that
collect, analyse and
disseminate data on
orphans and vulnerable
children
Support National Orphans
and Vulnerable Children
Steering Committee
Provide
support
and
standardise childcare for
orphaned children.
49
HANDOUT ON PLANNING
HIV/AIDS PROGRAMMES IN ZAMBIA
According to the National AIDS/STI/TB Bill passed in December 2002, the National
AIDS Council (NAC) has been established as a body corporate with perpetual succession
and a common seal, capable of suing and being sued in its corporate name, and with
power, subject to the Act, to do all such acts and things as a body corporate may by law
do or perform.
The Vision of the National AIDS Council is to have a nation free from Human
Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS).
The Mission of National AIDS Council is to provide leadership for a coordinated fight
against HIV/AIDS in order to eliminate HIV/AIDS and associated opportunistic
infections for the benefit of the Zambian society.
The Goal of the National AIDS Council is to reduce HIV/STI transmission among
Zambians and reduce the socio-economic impact of HIV/AIDS.
The National Guiding Principles for the national response to the HIV/AIDS epidemic are:
People centred
People shall be in the centre of the solution
•
Respect for the basic human rights of all persons and that stigma and discrimination
against people with HIV/AIDS are eliminated;
•
Gender mainstreaming in HIV/AIDS issues is a central element in the fight against
the epidemics;
Culturally sensitive
•
Solutions and approaches utilised in the course of the response shall be culturally
sound and reflect the positive values of Zambians.
Priority centred
•
Priority shall be accorded to groups at high risk and associated geographical areas.
The promotion of integrated approaches
•
HIV/AIDS/STI/TB is a serious public health, social and economic problem
affecting the whole country and thus to be addressed as a political, developmental
and security national priority, requiring a multi- sectoral approach;
The Strategic Objectives for 2002 – 2005
•
To promote the implementation of multi-sectoral behavioural change campaigns
•
To minimise Mother to Child Transmission of HIV
•
Make transfusion and use of sharp instruments safe
50
•
•
•
•
•
•
To improve the quality of life of people living with HIV/AIDS by encouraging positive
living, good nutrition and prevention of Opportunistic Infections.
To provide appropriate care, support and treatment to HIV/AIDS infected persons.
To provide appropriate care, support and treatment to HIV/AIDS infected persons.
To provide improved care and support services for the Orphans and Vulnerable
Children,
To improve HIV/AIDS information, management and decision making.
To assure impartial, transparent and effective programme operations.
Efforts to mainstream gender in Zambia: Government and NGOs experiences
There are several institutions and organizations that are involved in the implementation of
HIV/AIDS programmes in the country. However, very few have attempted to mainstream or
integrate gender in their implementation.
Government
Government programmes that are trying to mainstream were outlined which include the
Poverty Reduction Strategic Programme (PRSP) and Education Strategic Plan of 2003-2007.
Gender Focal persons in all ministries and provinces have been appointed.
Ministry of Health (MOH) through the Central Board Health are currently implementing the
general programmes such as.
• Anti Retroviral Drugs and treatment of patients.
• Prevention of mother to child Transmission (PMTCT).
• Voluntary and Confidential HIV/AIDS Counseling and Testing.
• Safe motherhood programme
Non-Governmental Organizations
Non government and community Based organization such as Family Health Trust, Society
for Family Health (SFH) Planned Parenthood Association of Zambia (PPAZ), SWAAZ, Kara
Counseling implement programmes. Programmes are targeted at promotion of condoms use
and counseling. Women movement and cooperating partners are also implementing some
programmes related to gender and HIV/AIDS.
Political will should be provided in terms of
• Resource allocation
• Representation
• Coordination role
• Policy formulation, legislation
In these programmes, gender gaps could be identified and to improve the situation, the
following are proposed.
•
Provision of enabling environment in terms of policy and legislation to protect the
rights of women, girls including men and boys.
•
Coordination. Government should play a cardinal role in coordinating the efforts being
made by different institutions/organizations.
• Undertaking gender analysis and impact assessment using disaggregated data.
• Provision of resources for capacity building.
51
MODULE FIVE:
MONITORING AND EVALUATION
Purpose
To introduce participants to concepts of M & E in order to enhance result oriented
activities.
Objectives
At the end of the session, participants should be able to:
Recognize strategic elements of gender-specific M&E and reflect on their
application in HIV/AIDS M&E plan
Define terms used in monitoring and evaluation
Methodology
Brainstorming, Presentation (TBA)
Group Discussions (TBA)
Aids
-
-
Facilitators notes, Over head projectors/transparencies
LCDs, Flip charts, Chalk boards/white boards, Markers
Materials
Overhead 1: “definition of monitoring and evaluation”
Overhead 2: Levels of monitoring and evaluation
Session Guide
Introduction
1.
•
•
•
Work on HIV/AIDS centres around
Prevention of new infections
Care for PLWA
Mitigation of impacts of AIDS on the infected and affected
2.
•
Gender mainstreaming refers to:
Ensuring that the gender issues are visible in situation analyses and problem
statements
Explicit reference to the gender issues in policy statements and development goals
Ensuring that program objectives explicitly address the identified gender issues
The gender issues are explicitly addressed in program/project design and
implementation
Ensuring that the monitoring and evaluation instruments and data facilitate
visibility of progress in addressing the gender related goals and objectives
•
•
•
•
52
3.
At the beginning of the session, ask the participants about their understanding of
“Monitoring” and Evaluation. Discuss different definitions until consensus is
achieved. Show Overhead 1.
Emphasise that monitoring and evaluation are interrelated activities. They should
be performed on a regular basis.
4.
With reference to the planning cycle or matrix, explain the different levels of
M&E
Conceptual Framework of HIV-AIDS
Planning Cycle
Annual
HIV-AIDS
Report
1
HIV-AIDS Strategy
of Zambia
[a]
[h]
Planning
Processes
Intermediate
M&E
INPUTS
[b]
ACTIVITIES
[c]
indicators
OUTPUTS
[d]
Final
REACH
(Access,
Use, &
Satisfaction)
indicators
OUTCOMES
[f]
IMPACTS
[g]
[e]
’
Bureaucratic Processes [Efforts]
Development Effects [ Results]
Adapted from, Kwame M. Kwofie, John T. Milimo and Jim Edgerton, Building Blocks for Designing a National Monitoring & Evaluation S ystem: A Zambia Case Study, August 2002.
8
The approach takes a more holistic view of monitoring .
For each of these situations, indicators at all four levels need to be developed and
monitored. These levels are:
Inputs referring to the financial and physical indicators of resources provided, including
the salaries of staff and other recurrent costs;
Outputs, which are the goods and services generated through these inputs;
the Outcomes, which refer to the actual access, use of, and satisfaction of the targeted
groups of society with these services/policies; and
the Impacts, which are the directly attributable benefits for the people, the country, the
environment.
53
TYPES OF INDICATORS AND LEVELS OF M&E
Global/regional level - Beijing platform for action, NEPAD, UNGASS
National level
-
National development plans, PRSP, Sector policies, sector
budgets, national gender policy, National HIV/AIDS policy
Sector/organisational level- sector ministries, private sector, NGO sector
Sub-national level/Provincial levels – programmes, projects, districts/local levels
5.
EXERCISES ON DIFFERENT LEVELS
5.1.
Global/Regional Level-
Review the impact for the response to HIV/AIDS pandemic for men and women of
international policies such as Beijing platform for action, NEPAD, UNGASS.
For example, following the introduction of the Structural Advancement Programme
(SAP), there were budgetary cuts in basic social services such as health and education as
well as the introduction of a cost recovery system that included fees for health care
services. The impact of this policy was that it further marginalized women’s reproductive
and health rights since they could no longer afford treatment.
54
5.2
National Level-
5.2.1. Government
As an entry point to gender mainstreaming in HIV/AIDS at national level, kindly review the
National development plans, PRSP, Sector policies, sector budgets, national gender policy,
National HIV/AIDS policy for the following:
-
-
-
The extent to which the National Gender Policy is taken into account when designing
the National HIV/AIDS Policy and The National HIV/AIDS Intervention Strategic
Plan.
To what extent the policy address gender representation in the various levels of
leadership working in response to HIV/AIDS
The extent to which the policy reinforce the need for existing lega l framework
(inheritance law, property laws, family laws, employment laws) to address gender
inequalities and human rights violation in the light of HIV/AIDS.
The extent to which the policy strategies are addressing the practical and strategic
gender needs
Percentage resource allocation to activities benefiting women and men (gender
sensitive budget analysis)
5.2.2. AIDS Service Organisations (ASO)
Number of ASOs with gender explicit policies, development goals, program objectives and
project/program design
Number of ASOs incorporating gender training as part of on-going staff development and
community education activities
The proportions of program budgets that are gender specific.
5.2.3. Data Collection At National Level
The collection of impact and outcome data-surveillance of HIV and the behaviours that
spread it-should remain a national activity, carried out under the auspices of central
government.
The responsibility for monitoring and evaluating the multisectoral responses to AIDS in each
sector lies with the M&E staff in the relevant ministry or service organisation. The
information they collect should be passed to the National AIDS Council which can
incorporate it into national statistics. This allows for knowing the contribution that their
sector is making to reducing the spread and impact of AIDS. At the national level,
programme managers need just enough information to determine whether the national effort
is going in the right direction. This information helps them plan for the future and lobby for
necessary resources, legislative changes etc. At this level, one or two core indicators for each
programme area, aggregated from a representative sample of sites will be sufficient to give
an idea of whether the national response is making any significant headway against the
epidemic. Design easy to use reporting forms for collection of standardized data at project
level, and ensure that national data needs are met. These tools can also be used by line
ministries and sectors.
55
Impact
% y o u n g p e o p l e a g e d 1 5-2 4 y e a r s o f a g e w h o a r e H I V
Infected = 16.4% (Sentinel Surveillance 2002)
(Target: 25% in most affected countries by
2005; 25% reduction globally by 2010)
% of infants born to HIV infected
m o t h e r s w h o a r e i n f e c t e d =3 9 %
(Target: 20% reduction by 2005;
50% reduction by 2010)
Outcome
(Direct
b e n e f i t sutilisation o f
services)
Knowledge/Behaviour
- % o f r e s p o n d e n t s 1 5-2 4 y e a r s o f a g e w h o b o t h
Correctly identify ways of preventing the sexual
transmission of HIV and who reject major
misconceptions about HIV transmission or prevention
= 37.8% (ZSBS 2000)
(Target: 90% by 2005; 95% by 2010)
-% o f p e o p l e a g e d 1 5 -2 4 r e p o r t i n g t h e u s e o f a
C o n d o m d u r i n g s e x u a l i n t e r c o u r s e w i t h a n o n-r e g u l a r
Sexual Partner
Males 1998 (38%) 2000 (42%),
Females 1998 (21%) 2000 (40%) (ZSBS 2000)
Impact alleviation
R a t i o o f o r p h a n e d t o n o n -o r p h a n e d
c h i l d r e n 1 0-1 4 y e a r s o f a g e w h o a r e
currently attending school
(0.14 for both boys and girls MOE)
Output
(Goods and
services)
Prevention
- % of schools with teachers who have been trained in
life- skills -b a s e d e d u c a t i o n a n d w h o t a u g h t i t d u r i n g t h e
last academic year =1.5% (Ministry of Education)
-% e n t e r p r i s e s / c o m p a n i e s t h a t h a v e H I V / A I D S
workplace policies and programmes
-% o f H I V + p r e g n a n t w o m e n r e c e i v i n g a c o m p l e t e
course of ARV prophylaxis to reduce the risk of
M T C T =3 . 0 9 %
Care/Treatment
% of patients with sexually
transmitted infections at health care
facilities who are appropriately
diagnosed, treated and counselled
National Composite Policy Index
Government funds spent on HIV/AIDS
30, 8 billion kwacha (est. from yellow book PRSP)
Note: 25% of PRSP budget was used
Increased resources,
E x p a n d e d p a r t n e r s h i p s a n d m u l t i -s e c t o r a l
Measures/
Input
5.3.
% of people with advanced HIV
infection receiving ARV combination
therapy=0.1%
policy development.
Sector/Organisational And Programme Level-
Using the given example of gender sensitive indicators for an HIV/AIDS programme, kindly
review “Outline of Summarised and Costed M&E Plan for HIV/AIDS”
Kindly engender the M&E plan
Gender mainstreaming indicators at sector and programme level.
Goal:
Reduce HIV/STD transmission among Zambians and reduce the socio–economic impact of
HIV/AIDS.
Impact indicator
% of adult men and women aged 15-49 who are HIV infected reduced from 19% to 15% by
2005.
Outcome indicators
Increase in women accessing PMTCT
Decrease in STI incidence rate in men and women
Increase in the number of women and men accessing VCT
Increase in the girls attending school
The extent to which women make sexual and reproductive choices
Change in perception of men and women in HIV/AIDS transmission
Increase in men’s participation in Home based care
Number of men and women adopting safe sex practices
Increase in women’s access to credit and productive resources
56
Output indicators
Number of women and men accessing condoms
Number of men and women receiving information on HIV/AIDS
Number of men and women accessing health care
Number of HIV/AIDS messages addressing gender issues
Number of men and women involved in HIV/AIDS prevention activities
Gender balance in the staff giving out HIV/AIDS information
Input indicators
Amount of resources allocated to the development of messages for men and women
Number of HIV/AIDS prevention courses planned for men and women participants
Number of gender training programme planned
Amount of funds allocated to research in gender sensitive issues in HIV/AIDS
Ratification and implementation of global or international treaties e.g Beijing Platform for
Action,
Outline of Summarised and Costed M&E Plan
Objectives & Outputs
Key Performance Indicators (WHAT)
Frequency or
Means of
Verification
Cost US$
(‘000)
WHO
VISION:
A nation free from Human Immunodeficiency Virus and Acquired Immunodefiency syndrome (HIV/AIDS)
GOAL:
Reduce HIV/STD transmission among Zambians and reduce the socio–economic impact of HIV/AIDS.
% of pregnant women aged 15-19 who are HIV
infected reduced from 15% to 11% in 2005 (
15-24)
(2,500)
CSO
2,500
CSO
HIV
sentinel
Surveillance reports
4-5 years
% of adult men aged 15-49 who are HIV
infected reduced from 19% to 15% in 2005.
OBJECTIVE 1:
Promote implementation of multisectoral behaviour change campaigns and health seeking behaviours
Outputs:
1.Improved
levels
awareness
2.Sexual abstinence among
the youth and unmarried
people promoted
3.Practice of one sex partner
promoted and Dry sex
discouraged
4.Condoms
available
made
% of youths (15-24) who both correctly identify
ways of preventing the sexual transmission of
HIV and who reject major misconceptions
about HIV transmission from increased from
92% to 99%.
Sexual
Surveys
Behaviour
2 years
Increase abstinence among youths (15-19 yrs)
from 25% to 50%
% reporting ever had sex at 15 years
decreases from 25% for boys and 18% for girls
to 20% for boys and 10% for girls.
readily
5.Early
and
effective
diagnosis and treatment of
STD ensured.
% of 15-49 year olds using condoms during the
last sexual act with a non marital sexual partner
increases
from:
–
39%
for
men
to
60%
–
31%
for
women
to
50
Reports on condom
sales,
distribution,
line ministry activities
184
Line
ministrie
s
SFH/PPA
Z
Yearly
% of schools with teachers trained in life skills
based HIV/AIDS education and who taught it
during the last curriculum year
% of pts with STIs appropriately diagnosed,
treated and counseled from 10% to 50%
CSO
Survey
2 years
3,920
CSO
Health
Surveys
Facility
2,500
57
Objectives & Outputs
Key Performance Indicators (WHAT)
Frequency or
Means of
Verification
Cost US$
(‘000)
WHO
OBJECTIVE 2:
MTC transmission of HIV minimised
Cohort analysis of
new born babies
based on programme
coverage/2 years
3,770
CBOH/M
OH
% of HIV positive women attending ANC
receiving complete course of ARV therapy to
prevent MTC
Programme
monitoring /2 years
3,770
CBOH/M
OH
% of all functioning referral and provincial
hospitals and 80% of all district hospitals
integrate PMTC service.
HMIS
or
Service
utilization data.
% of infants born to HIV infected mothers who
are infected reduced from 39% to 28%
Outputs:
1. Adequately sensitized
communities in PMTCT
2. Adequate PMTCT service
facilities
3.Infant feeding options for
HIV/AIDS infected mothers
encouraged
Communities sensitized
1,500
Yearly
OBJECTIVE 3:
Make transfusion and use of sharp instruments safe
Outputs:
% of all functioning referral, provincial and
Management
district hospitals have stocks of safe blood and
procedures, guidelines &
blood products
standards reviewed
Adequate
screening centers,
equipment provided
Use of sterile
syringes, blades, needles
and other sharp instruments
encouraged
HMIS
or
Service
utilization data. And
Reports
CBOH/M
OH
672
ZNBTS
CBOH/M
OH
Quarterly
OBJECTIVE 4:
To improve the quality of life of HIV/AIDS infected persons without symptoms by encouraging positive living, good nutrition, prevention
of opportunistic infections and avoiding high risk behaviour.
1,290
Civil
% of public and private institutions where VCT Programme
society,
services for HIV are provided and /or referred monitoring
CBOH
to other facilities
Yearly
Private
sector
Outputs:
1.VCT centres established in Percentage of large enterprises/companies that Survey/2 yearly
2,500
CSO
all districts
have HIV/AIDS workplace policies/programmes
2.Advocacy campaigns for
support services and human
rights undertaken
3.Prevention of opportunistic
infections (OIs) and
preventive TB therapy
provided
Reports /Quarterly
1,290
Labour
ministry
of
Zambia
Federati
on
of
Employe
rs,
Unions
4.Institutions offering
counseling training
strengthened
58
OBJECTIVE 5:
To provide appropriate care, support and treatment to HIV/AIDS infected persons
opportunistic infections by the year 2005
Number of smear + TB cases per 100,000
Outputs:
1.Treatment for Tuberculosis population
and
other
opportunistic
infections provided.
Number of deaths from TB (all forms) per 100,000
2.Anti -retroviral therapy (ART) pop. per year
for PLWAs introduced in public
and private health facilities
% of advanced HIV infection receiving ARV
3.Improved home based care
combination therapy.
and support services for the
infected provided.
Number of support groups
4.Mechanism for validation of
the efficacy of traditional and
alternative
remedies Traditional & Alternative Remedies subjected to
established.
validation
and those affected by HIV/AIDS, TB, STIs and other
Programme
monitoring/Yearly
3,000
Programme
monitoring/2 yearly
10,000
CBOH/M
OH
CBOH/M
OH
Records of remedies
subjected
to
validation/yearly
6,000
SCIENTIF
IC
RESEAR
CH
Objective 6:
To provide Improved care and support services for the orphans, vulnerable children and others affected and at risk such as refugees,
prisoners, disabled people by the year 2005
Number of organizations providing counseling, Independent evaluation
Outputs
1.Organizations that provide care and support services to OVC
reports of community, 3,000
UNZA
education, physical, material,
district and national
social, mental and spiritual
HIV/AIDS programs
support to orphans and
vulnerable children created
2 yearly
and strengthened
2.Integration and reintegration
of street children including
better referral and placement
of street children
Ratio of current school attendance among orphans
to that among non-orphans aged 10-14
Population
survey
2 yearly
based
5,000
CSO
Percentage of children less than 15 years old who
are orphans
Objective 7:
To improve HIV/AIDS information management and decision making
Regular Monitoring and 500
Outputs
Accessibility of HIV/AIDS information
Evaluation Reports
1. Monitoring and Evaluation
(M&E) Capacity Developed
Number and type of research conducted
2.
Programme
specific
interventions
regularly
monitored
3.
Operational
research,
sexual behaviour research,
sentinel
surveillance
and
vaccine
development
supported
4. Ability to Provide Technical
Support Developed
Objective 8:
To assure impartial, transparent and effective programme operations by improving coordination of multi sectoral implementation of interventions
NAC is fully functional and Policy is being Country
Assessment
NAC.
400
Outputs
implemented through the National Strat egic Questionaire
1. Institutional NAC
Framework and Implementation Action Plan
Coordination Capacity Built
2 years
2. Mechanisms, of multisectoral
response
operational at the National, No. of Legal reforms, policies and Guidelines
developed
Provincial and District levels
3.Increased
facilitation
of
sharing, of best practices for
priority areas.
(National Composite Policy Index)
54,296
59
5.4.
Sub-National Level/Provincial/Local Levels
District And Community Level
The data necessary at the project and the community level are different from those
needed at the national level. Projects need detailed information- information about who
they are reaching with what services, about the quality of their services, about how their
services are perceived in the communities they seek to reach-if they are to use the
information to improve their programming. Information on input and outputs is critical.
6.
FLOW OF INFORMATION AND REPORTING FREQUENCY
6.1.
Flow Of Information
Communities
-registers/surveys
-community volunteers
District level
-interpretation and action
Provincial level
-interpretation and action
National level
-resource center
-interpretation and action
6.2.
Reporting Frequency
Time frame for submission of quarterly reports and action
Level
Time required from the end of quarter to
report
Communities
Two weeks after the end of the quarter
District
Six weeks after the end of the quarter
Province
Seven weeks after the end of the quarter
National
Eight weeks after the end of the quarter
Action
Discuss analysis with community Committees
and plan action
Discuss analysis with DDCC/task force, adjust
quarter’s plan
Use information for performance visits of CBOs
District performance visits
Advise on support required for district
Decide on support to district
Assist monitoring of policy implementation and
standard compliance
National report to Council and partners
60
HAND OUT 1
Information to support Monitoring
Intermediate Indicators
?Tracking key Inputs
?Expenditure Tracking
?Implementation Problems
?Service Delivery(Access, Use)
? Core Output indicators
Zambia
HIV -AIDS
Strategy
[A]
MONITORING
HIV-AIDS STRATEGIC PLAN
? Where do we want to go?
? H ow do we get there?
[B]
? Where are we
Now?
? How do we
know if we
are getting
there?
[C]
EVALUATION
? How do we
know we got
there?
[D]
LESSONS
LEARNED
[E]
ANNUAL HIV_AIDS
REPORT [F]
© kmk/2002
24
Information Bases to support NAC Planning
Monitoring &Evaluation Processes
Zambia
HIV AIDS
Strategy
[A]
? Where
are we
Now?
ANNUAL HIV_AIDS
REPORT [F]
HIV-AIDS
STRATEGIC
PLAN
? Where do we
want to go?
? Ho w do we get
there?
[B]
MONITORING
? How do we
know if we
are getting
there?
[C]
EVALUA TION
?H o w d o
we know
we got
there?
[D]
LESSONS
LEARNED
[E]
9
© kmk/2002
61
HAND OUT 2
TYPES OF INDICATORS AND LEVELS OF M&E
The approach takes a more holistic view of monitoring .
For each of these situations, indicators at all four levels need to be developed and
monitored. These levels are:
Inputs referring to the financial and physical indicators of resources provided, including
the salaries of staff and other recurrent costs;
Outputs, which are the goods and services ge nerated through these inputs;
the Outcomes, which refer to the actual access, use of, and satisfaction of the targeted
groups of society with these services/policies; and
the Impacts, which are the directly attributable benefits for the people, the country, the
environment.
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NATIONAL LEVEL
The collection of impact and outcome data-surveillance of HIV and the behaviours that
spread it-should remain a national activity, carried out under the auspices of central
government.
The responsibility for monitoring and evaluating the multi-sectoral responses to AIDS in
each sector lies with the M&E staff in the relevant ministry or service organisation. The
information they collect should be passed to the National AIDS Council which can
incorporate it into national statistics. This allows for knowing the contribution that their
sector is making to reduce the spread and impact of AIDS. At the national level,
programme managers need just enough information to determine whether the national
effort is going in the right direction. This information helps them plan for the future and
lobby for necessary resources, legislative changes etc. At this level, one or two core
indicators for each programme area, aggregated from a representative sample of sites will
be sufficient to give an idea of whether the national response is making any significant
headway against the epidemic. Design easy to use reporting forms for collection of
standardized data at project level, and ensure that national data needs are met. These
tools can also be used by line ministries and sectors.
District and Community Level
The data necessary at the project and the community level are different from those
needed at the national level. Projects need detailed information- information about who
they are reaching with what services, about the quality of their services, about how their
services are perceived in the communities they seek to reach-if they are to use the
information to improve their programming. information on input and outputs
Types of Data Collection for Monitoring and Evaluation
Community level
Community registers
Vital statistics, including births, deaths,
migration, age and sex
Yearly community diagnosis
District level
Routine operational activities reports
Provide Inputs and outputs data and quantified.
Consolidate community data from public,
private and NGOs including research activities
National level
The collection of
The collection
impact dataoutcome data- the
surveillance of HIV,
behaviours that
STIs
spread HIVUsed for needs
assessment
Used for needs
assessment
Routine operational activities reports
Provide Inputs and outputs data and quantified
Performance visits
Supervisory visits and monitor compliance to standards
Assess operational performance
Reports
The responsibility for monitoring and
evaluating the multi-sectoral responses to AIDS
in each sector lies with the M&E staff in the
relevant ministry
This means bringing together all the data
available from all sources (line ministries,
surveillance reports, behavioural surveys,
academic research, programme information,
and other regular progress reports).
Performance visits
Analysis of policy
development compared
to targets formulated in
the strategic
framework
63
Example of routine information at various levels
a) District/provincial level structures (Government departments,
private sector and Civil society)
b) Community
Sector
Variables
(number of )
# of defilement cases
recorded , male and
female
# of workshops
attended, male and
females
Victim Support Unit
Workshops
Frequency of
collection
Daily
Frequency of
analysis
Quarterly
Source of
information
VSU records
As necessary
Annually
Human Resource. Dept
Flow of information and reporting frequency
Flow of information
Communities
-registers/surveys
-community volunteers
District level
-interpretation and action
Provincial level
-interpretation and action
National level
-resource center
-interpretation and action
Reporting frequency
Time frame for submission of quarterly reports and action
Level
Communities
Time required from the end of quarter
to report
Two weeks after the end of the quarter
District
Six weeks after the end of the quarter
Province
Seven weeks after the end of the quarter
National
Eight weeks after the end of the quarter
Action
Discuss analysis with community Committees and
plan action
Discuss analysis with DDCC/task force, adjust
quarter’s plan
Use information for performance visits of CBOs
District performance visits
Advise on support required for district
Decide on support to district
Assist monitoring of policy implementation and
standard compliance
National report to Council and partners
64
CASE STUDY II
HIV/AIDS PROGRAMME – MINISTRY OF MONGOLIA
The Ministry of Mongolia had experienced a high attrition (death) rates among the staff
in 2000. The situation became so bad that sometimes the Ministry would burry three (3)
staff in a week.
Consequently, management felt that the situation called for quick and drastic measures to
prevent the loss of staff. An HIV/AIDS committee was hurriedly constituted and in order
to prevent stigmatization, it was renamed Health and Welfare Committee. The
committee’s terms of reference included among others:h To recommend to management intervention measures to prevent further loss of staff.
h Link the Ministry of Mongolia with other organisations dealing in HIV/AIDS.
h Carry out sensitization among staff on the dangers of HIV/AIDS and how to prevent
it.
h Provide the sick with moral and material (food) support.
In less than a month, the committee had come up with recommendations on how to
reduce deaths at the Ministry. The committee came up with options on how to resolve
the problem. These included:h Opening a Clinic for Ministry of Mongolia staff only.
h Starting a revolving fund, which should be accessed by staff to purchase/buy
medications.
h Stocking of ARVs.
After the above recommendations were presented to management, it was discovered that
it was not possible to start a Clinic meant for Ministry of Mongolia alone as it was part of
the civil service, hence all other institutions would start to open their own Clinics.
The proposal to start a revolving fund was also found not to be feasible, the civil service
did not permit opening of accounts besides the mandate of the Ministry.
The purchase of ARVs was also found unattainable. To start with, the Ministry did not
have the personnel to administer and monitor the usage of the drug and above all the
source and cost of the drug was not known. This other option therefore fell off as well.
65
The only practicable option was to engage in sensitization programmes which all other
organisations in the country were engaged in and in addition, there was no capacity
ground to undertake the sensitization programme.
Management was still of the view that something practical had to be done which should
have a direct impact on staff. After brainstorming the issue for sometime, it was
proposed that procurement of food supplements would go a long way in prolonging the
lives of the sick staff. The Ministry settled on the procurement of Gorjis, a food
supplement and K50 million was given to the Health Committee to source the product.
The food supplement was procured and stocked at the Ministry and all staff were free to
collect the Gorjis from the committee members. There was a good response as most staff
were able to source the product. Within a period of two (2) months, Gorjis worth K30
million had been distributed to staff but there was no change in health status of the sick
staff and deaths were still being experienced. When an evaluation was conducted, it was
discovered that:h Actually the sick were not interested in the Gorjis as it was perceived to be meant for
the dying and even those who had initially shown interest started withdrawing due to
stigma perpetuated by the distributors.
h Most of the Gorjis product was being accessed by the seemingly health staff who took
the product to their sick relatives and in some cases, they started selling the product.
h No initial studies were undertaken to determine the numbers in terms of the sick, and
how they were getting infected.
h The committee members were not well prepared for the task, it was later learnt that
the committee members needed training in counselling and skills on how to handle
the sick.
In short, there was no proper planning on how to intervene in the health problems at the
Ministry. No situational analysis was conducted, hence the failure of the programme and
the strategies thereof.
66